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Category: Volume 07 Issue 01 January 2019
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Title: Total Knee Arthroplasty (TKA): Role of Drains

Authors: Dr K.V Santhosh Reddy, Dr Pramod Kumar. S

 DOI: https://dx.doi.org/10.18535/jmscr/v7i1.30

Abstract

 

Placement of closed suction drains after total knee arthroplasty is an age-old practice; however, benefits and disadvantages of this procedure remain disputable in various studies. Although there is no established evidence to support the use of drains in total knee arthroplasty (TKA), they are thought to reduce the formation of a haematoma and the incidence of deep infection. The aim of the study was to assess the need for drainage after total knee arthroplasty (TKA). This study was conducted at tertiary care hospital, Nizambad after obtaining permission from the hospital ethics committee. This includes two groups of patients each 30 of both sexes, undergoing total knee arthroplasty. In control group drains were placed and in study group there was no drain. TKA was performed in most of osteoarthritis patients and few were suffering with rheumatoid arthritis. In this study noted significant average reduction of haemoglobin and haematocrit in drained patients on the first postoperative day.  Most of patients in the study group required a change of dressing in the first 24 h and had ecchymosis when compared to the control group. There was a statistically significant difference in the duration of hospital stay with the control group requiring a longer stay in the hospital. The visual analog score was higher in control group than in study group, observed differences in the mean VAS values between both groups but these values were not significant. This concludes that there were benefits in terms of lower analgesic intake, lower blood loss on the first postoperative day and lower need for dressing reinforcement, but increase in hospital stay.

Keywords: Total knee arthroplasty, drains, hematoma, analgesics, VAS score.

References

  1. Seo ES, Yoon SW, Koh IJ, Chang CB, Kim TK. Subcutaneousversus intraarticular indwelling closed suction drainage afterTKA: a randomized controlled trial. Clin Orthop Relat Res.2010;468(8):2168–76.3
  2. Waugh TR, Stinchfield FE. Suction drainage of orthopaedic wounds. J Bone Joint Surg Am 1961;43-A:939–46.
  3. K˛eska R, Paradowski TP, Wito´nski D. Outcome in primarycemented total knee arthroplasty with or without drain: aprospective comparative study. Indian J Orthop.2014;48(4):404–9.6.
  4. Gibon E, Courpied JP, Hamadouche M. Total joint replacementand blood loss: what is the best equation? Int Orthop. 2013;37(4):735–9.
  5. Parker MJ, Roberts CP, Hay D. Closed suction drainage for hip and knee arthroplasty. A meta-analysis. J Bone Joint Surg Am 2004;86-A: 1146–52.
  6. Chandratreya A, Giannikas K, Livesley P. To drain or not drain: literature versus practice. J R Coll Surg Edinb 1998;43:404–6.
  7. Waugh TB, Stinchfield FE. Suction drainage of orthopaedic wounds. J Bone Joint Surg [Am] 1961;43-A:939-46.
  8. Alexander JW, Korelitz J, Alexander NS (1976) Prevention of wound infections. A case for closed suction drainage to remove wound fluids deficient in opsonic proteins. Am J Surg 132(1),59–63.
  9. Cheung G, Carmont MR, Bing AJ, Kuiper JH, Alcock RJ, Graham NM (2010) No drain, autologous transfusion drain or suction drain? A randomised prospective study in total hip replacement surgery of 168 patients. Acta Orthop Belg 76(5), 619–627.
  10. Dora C, von Campe A, Mengiardi B, Koch P, Vienne P. Simplified wound care and earlier wound recovery without closed suction drainage in elective total hip arthroplasty. A prospective randomized trial in 100 operations. Arch Orthop Trauma Surg 2007;127:919‑23.
  11. Li C, Nijat A, Askar M. No clear advantage to use of wound drains after unilateral total knee arthroplasty: A prospective randomized, controlled trial. J Arthroplasty 2011;26:519‑22.
  12. Ritter MA, Keating EM, Faris PM. Closed wound drainage in total hip or total knee replacement. A prospective, randomized study. J Bone Joint Surg Am 1994;76:35‑8.
  13. Parker MJ, Roberts CP, Hay D. Closed suction drainage for hipand knee arthroplasty. A meta-analysis. J Bone Joint Surg Am.2004;86(6):1146–52.
  14. Goes RFA, Silva AF, Lyra FS, Loures FB, Palma IM, Cobra HAA,et al. Estudo prospectivo randomizado após uso de dreno naartroplastia total do joelho com implante. Rev Bras Ortop.2013;48(3):257–62.19
  15. Willemen D, Paul J, White SH, Crook DW. Close suctiondrainage following knee arthroplasty. Effectiveness and risks.Clin Orthop Relat Res. 1991;264:232–4.21.
  16. Senthil Kumar G, Vonarx OA, Pozo JL (2005) Rate of blood loss over 48 hours following total knee replacement. Knee 12, 307–309.
  17. Holt BT, Parks NL, Engh GA, Lawrence JM. Comparison of closed‑suction drainage and no drainage after primary total knee arthroplasty. Orthopedics 1997;20:1121‑4.
  18. Confalonieri N, Manzotti A, Pullen C. Is closed‑suction drain necessary in unicompartmental knee replacement? A prospective randomised study. Knee 2004;11:399‑402
  19. Busch CA, Shore BJ, Bhandari R, Ganapathy S, MacDonald SJ, Bourne RB, et al. Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. J Bone Joint Surg Am 2006;88:959‑63.
  20. Stein C. The control of pain in peripheral tissue by opioids. N Engl J Med 1995;332:1685‑90.

Corresponding Author

Dr Pramod Kumar. S

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